HB 1487 (Stolle)/SB 878 (Dunnavant) require local Community Services Boards (CSBs) to provide mental health and substance abuse services for individuals incarcerated in local and regional jails. The bills also provide that an individual who is discharged from a local or regional jail may continue to receive services from the CSB that provided services in the jail or the CSB serving the locality in which the individual will reside after being released from the jail. As introduced, the bills do not have a delayed effective date, but contain language providing for the Board of Corrections to establish standards for the provision of mental health and substance abuse services in jails, to include the requirement that each sheriff enter into an agreement with the local CSB and that each regional jail superintendent enter into an agreement with each CSB serving the localities participating in the regional jail. HB 1487 was amended in subcommittee to require that the CSB would be required to provide these services upon request of the sheriff or regional jail superintendent. The bills provide that the CSB will bill the local or regional jail for its services.

The issue of health care in jails and prisons is currently under review by the Joint Commission on Health Care, which released an interim report on its two-year study in September 2017. The preliminary report noted that jails take varying approaches to the provision of health care, with some jails contracting for physical and mental health care and some jails working with their local CSBs to provide mental health and substance abuse treatment services. The Joint Subcommittee to Study Mental Health Services in the Commonwealth in the 21st Century is also examining the appropriate structure and financing of the CSB system.

VACo recognizes the need to provide health care, including mental health care, in jails in a cost-effective manner. Local and regional jails receive state assistance with jail costs via state funding for salaries provided through the Compensation Board and per diem payments to assist with housing inmates, but localities bear a substantial portion of costs for inmate care, including mental health and substance abuse treatment. Localities also contribute substantially to their local CSBs. VACo has expressed concern about how state funding would support the provision of services as envisioned in the bill. Two major questions that are still unanswered are whether state funding would be provided to the CSBs to support the costs of providing these services, or if the services would be expected to be funded out of existing allocations, and how funding these services through the CSBs would affect the local contributions to the jails.

VACo has been working with a coalition of stakeholders on a package of budget amendments that would assist with the issue of connecting individuals to services in the community when they are discharged from jails. The budget amendments would provide the infrastructure needed to streamline inmates’ enrollment in Medicaid so that their inpatient hospitalization could be covered during their time in jail and so that eligible inmates could be immediately enrolled in Medicaid upon release – a particularly important element in the reentry process for inmates with serious mental illness who may be eligible for the GAP program (which provides a limited package of Medicaid benefits for individuals with serious mental illness who would otherwise not qualify for the full Medicaid program).